October is Breast Cancer Awareness Month. I didn’t realize that when I first wrote this post but it works in well with today’s topic. I recently received the letter telling me that my annual mammogram showed no signs of breast cancer. Very reassuring and, to me, well worth the few moments of discomfort caused by the mammogram.
Not everyone agrees. There are a number of women out there who won’t go for a mammogram without really knowing why. I believe that whether or not someone goes for a mammogram is a personal decision but it should be a decision based on fact, not rumors or innuendo.
Breast cancer is the most common cancer among Canadian women and also occurs in men.
Find more information about the signs and symptoms here: http://www.cancer.ca/en/cancer-information/cancer-type/breast/signs-and-symptoms/?region=bc
More information for breast cancer in men can be found here: https://www.cancer.ca/en/cancer-information/cancer-type/breast/breast-cancer/breast-cancer-in-men/?region=on
Breast Cancer Facts:
- In 2014, an estimated 24,400 Canadian women will be diagnosed with breast cancer. 5,000 will die from it;
- About 210 men are expected to be diagnosed with breast cancer and 60 will die from it.
- In 2013, an estimated 232,340 new cases of breast cancer were expected to be diagnosed in women in the USA. 39,620 were expected to die from it;
- About 2,240 new cases of breast cancer were expected to be diagnosed in men in 2013.
Benefits of Screening Mammograms:
- In 2011 and 2012, approximately 1,138,000 (60%) Ontario women, 50–74 years old, were screened for breast cancer with a mammogram;
- In 2012, approximately 98% of Ontario women 50-74 years old, who had an abnormal mammogram, were fully diagnosed within 6 months.
According to the Ontario Breast Screening Program, “Breast cancer screening mammograms find cancers when they are small and less likely to have spread. Early detection means that most women have more treatment options, a reduced chance of cancer recurrence, and an improved chance of survival.” http://www.csqi.on.ca/type/
The National Cancer Institute (USA) Fact Sheet, as at 03/25/2014 states: “Screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74. It is recommended that women in this age group have a mammogram every two years. If there are risk factors, such as family history of breast cancer, this could change to a younger age or greater frequency.” http://www.cancer.gov/cancertopics/factsheet/detection/mammograms
Thanks to improvements in screening, detection and treatment, the 5 year survival rate for men is 80% and for women is 88%.
A woman stands in front of the mammography machine and her breast is placed between the two plastic compression plates. Two views – from different angles – are taken of each breast. Compressing the breast does cause a certain amount of discomfort, but it only lasts a few seconds. The compression is necessary because it increases the clearness of the image and allows less radiation to be used.
What exactly is a mammogram?
- A mammogram is a low-dose x-ray that produces an image of the inner breast;
- Can be used to identify a small cancer in a curable stage;
- Having a first mammogram at age 40 sets a base-line and allows further mammograms to identify minor changes to the breast over time. This helps to detect breast cancer at an early stage.
- It is the most efficient screening method, at this time, to detect early breast cancer;
There are two types of mammograms:
- Screening mammogram, used as a preventative tool to check for breast cancer in women who have no sign of the disease;
- Diagnostic mammogram, checks for breast cancer after a lump or other sign or symptom of the disease has been found.
What can a screening mammogram show up?
- Changes to the breast structure;
- Lumps that are too small to be felt;
- Abnormal areas of the breast;
- Micro-calcification (small deposits of calcium that sometimes indicate the presence of breast cancer);
Risks associated with mammograms:
Mammograms are not foolproof and it is necessary to be armed with the facts. If not sure about any information received, insist on clarification. Following are some of the limitations of the screening mammogram:
- False-positive results: the mammogram may show an abnormality, which must be followed up with additional testing – diagnostic mammograms, ultrasound and/or biopsy;
- False positives are more common for younger women, women who have had previous breast biopsies, and women who are taking estrogen (hormone therapy);
- False positives can cause anxiety and additional tests can cause physical discomfort;
- False-positive results can lead to overdiagnosis and overtreatment.
Overdiagnosis and Overtreatment – this is where you ask all the questions and want to know all the reasons for treatment:
Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS). DCIS are noninvasive tumors in which abnormal cells, that may become cancerous, build up in the lining of breast ducts and therefore need to be treated. Screening mammograms can also find cancers or DCIS that will never cause symptoms or threaten a woman’s life and therefore not needing treatment. Unfortunately, doctors often cannot distinguish between the two, and so to be safe, they are all treated. This exposes women unnecessarily to the adverse effects associated with cancer treatment.
More information about overdiagnosis and overtreatment can be found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410748/
Other limitations include:
- False-negatives: Screening mammograms miss about 20% of breast cancers present at time of screening. The main cause is high-breast density, occurring more often among younger women who normally have greater breast density.
- False-negatives can lead to delays in treatment and a false sense of security.
Since mammograms require very small doses of radiation, the risk of harm from this radiation exposure is extremely small. However, repeated x-rays do have the potential to cause cancer. This is definitely something that should be discussed with your health care provider.
There is a lot of controversy going on at this time about the value of the screening mammogram. My personal opinion is this: This procedure can and does detect early tumors and/or changes in the breast which to me makes it an important tool. However, I strongly believe that we can’t just blindly accept any procedure or diagnosis. We need to do our homework and find out as much as we can about any potential problems and/or treatments. Never let the health care system intimidate you. Always stay in charge of your body and your health.
How do you feel about the screening mammogram?
Please don’t forget to share.
Talk to you again next week,
Doctor at Computer – Image courtesy of imagerymajestic at FreeDigitalPhotos.net
Pink Ribbon – Image courtesy of scottchan at FreeDigitalPhotos.net